Myth 11. There are 46 million or more Americans without “health care.”

No one, to our knowledge, has actually come up with an estimate of the number of residents in America, legal or illegal, who are denied life-saving medical care—if indeed there are any. Even accusations of violating EMTALA—the Emergency Medical Treatment and Active Labor Act, which requires screening and stabilization of any patient presenting to an emergency room—are apparently rare.

The 46 million are the “uninsured.” They lack “coverage,” not care.

The Institute of Medicine and the Kaiser Commission on Medicaid and the Uninsured have published widely cited 2002 reports concluding that uninsured people have worse health than insured people. The IOM guesstimates that 18,000 people a year die for lack of insurance—an impressive sound bite that “has no factual basis,” writes Greg Scandlen.

In the actual report, the number 18,000 occurs only once, in Appendix D, with a description of the convoluted method for calculating it—extrapolating from one questionable estimate from one study.

Scandlen observes that neither IOM nor Kaiser did any original research, but simply compiled previous studies. These identify a correlation between lack of insurance and poor health, but cannot determine whether one is caused by the other, or both are caused by some other factor.

In the U.S. 37% of people with below-average income reported that they were in fair or poor health, while only 9% of people with above-average income said the same. A similar disparity is seen in the UK, New Zealand, Canada, and Australia, despite their “universal coverage.”

People in lower income groups are more likely to be uninsured, but only 18 of the 164 separate studies made any effort to control for income. The Medicaid population, being low income and well-insured, could serve as a control group. In 61% of the 31 studies that identify three populations (privately insured, uninsured, and Medicaid), Medicaid recipients appeared to do as badly or worse than the uninsured in receiving medical services or maintaining good health. In many cases, they have worse outcomes than the uninsured. This is consistent with other information suggesting that income is a much better predictor of health than is insurance status (ibid.).

Smoking and education level were other confounding variables that the IOM failed to consider (David Hogberg, American Spectator 9/22/09).

While the increasing number of uninsured is presented as a crisis, the proportion of Americans without health coverage has changed little in the past decade. The increase in number is owing to immigration and population growth, writes Devon Herrick.

In 2006, 15.5% of Americans were uninsured, compared with 16.2% in 1997.

Of the claimed 46 million uninsured, 12.6 million (27%) are immigrants, either legal or illegal. Up to 14 million (30%) are eligible for government insurance, but haven’t bothered to enroll. They can sign up the instant they need medical attention.

The percentage of low-income people (<$25,000/yr) without insurance actually decreased 24% over the past 10 years. The highest rate of increase in uninsured status, 90%, was in families with incomes over $75,000, who presumably could have bought insurance if they considered it worth the price.

Insurance “coverage” is not the same thing as medical care. It is not necessarily the best way to pay for medical care—although it probably is the most expensive. And there is no actual evidence, only inference from uncontrolled observational studies, that increasing the level of insurance coverage improves health outcomes. If expanding coverage means restricting care, the opposite could occur.

Additional information:

9 thoughts on “Myth 11. There are 46 million or more Americans without “health care.”

  1. Fascinating statistics.Does Congress have them?This datea mitigates against the “Uninsured arguement” to change health insurance.We have a problem that needs fixing, but the logic is true-true not related.Also, the concept that an “existing system” needs to be fixed is not valid since there is no system . There are a bunch of added-on projects with minimial inegration and no strategic plan in the first place.

  2. The reason most physicians went into medicine is because we value human life. The number of uninsured people is not the point. The number of underinsured is not the point. The point is there are people in our country that are dying and suffering unnecessarily because of how we (actively and passively) have structured health care in this nation. Because we as citizens settle for this, we as physicians and other allied health care professionals have partnered with this, we as insurance companies have engineered this, our government that we fail to hold accountable is coming up with a “bright idea” that is flawed called “public option”. Let us get back to basis. Let us return to the morals that are the bedrock of a democracy, republic and capitalistic society; value life.

  3. The system is NOT BROKEN! If one of the problems is catastrophic illness or trauma, address that problem and arrange to provide accordingly. If there are other issues that need modification, address them in a methodical manner.
    Don’t throw the baby out with the bath water!
    Most people are not unhappy with their health care, especially seniors.
    Why spend ourselves out of business just to re-invent the wheel?

  4. Tell a lie often enough and it becomes the truth. The essence of politics, especially the current administration.

  5. I sent this link to my congressman. We must look at the objective data lest we make critical decisions based upon propaganda. I suggest others pass this along to their congressmen.

  6. The issue here is poverty; not lack of insurance. The USA has been absorbing poor people by the millions in the last two decades, with huge numbers pouring in from Mexico, Asia, Eastern Europe (after the collapse of the Soviet Union), and Latin America. Poor people do poorly at everything: education, healthy living, law abidance, family rearing, work, you name it. Well controlled public health studies always control for socioeconomic status (SES) because the poor are so well known to have poor outcomes, no matter what. Their smoking, tatoos, drug use, drinking, violence, ignorance all conspire to drag down their survival outcomes. The Myth 11 article makes the key point that the poor in the UK, New Zealand, Canada, and Australia, “despite their universal coverage” have the same levels of “fair or poor health” as the poor in the USA. Universal coverage did nothing for them.

    Even if the USA were to spend itself into total bankruptcy providing universal coverage for the poor, it will not improve their outcomes, because the poor of the world will come to our shores in even greater numbers for free healthcare, and once here they reproduce much faster than the middle class or the rich. Our generosity is rewarded by even greater and ever growing problems.

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  8. I noticed all your sources are 5 years old.Hmm? All Americans deserve the right to life, liberty and pursuit of happiness. Yet Republicans are hell bent on not allowing this basic foundation for our fellow Americans. Sad indeed.

  9. @Hugh…and where does it say ‘healthcare’? Life, you have it. Liberty, same, for now. Pursuit of happiness, that’s on you. It’s not Republicans, it’s Americans that don’t want it, by majority. And the argument that a majority voted for Obama on a healthcare platform fails because they didn’t know what that platform would look like but when they started to they said they didn’t like it. 85% or so are happy with their employer provided plans, sounds like a majority. There is no constitutional basis for forcing a citizen to purchase something he doesn’t want, there is also none for the inequality in the taxation set forth in this mandate. The Progressives and Liberals are seeking the destruction of this country by weighing it down under entitlements no nation on this earth can bear. If it crumbles, then your life, liberty, and happiness are gone and if you come to my door looking for a handout you will have your answer at the business end of my 2nd Amendment Right…

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